Cost & Utilization Management

Optimize utilization and contain costs with clinical AI

Healthcare organizations have an abundance of data but often lack prescriptive insights. To fully understand where cost and utilization risks lie, healthcare organizations need to understand patients more holistically and address the risk factors that are often hidden in vast amounts of data. The Jvion CORE™ combines clinical, socioeconomic and other data sources to identify hidden risk that will drive what is often inappropriate utilization and costs. Armed with these insights, providers and payers can help direct patients to the right care setting before an acute event takes place. Specific actions and interventions can be deployed based on what is most impactful for each patient to drive better health, cost savings and care efficacy.

By integrating clinical data with socioeconomic data and leveraging the Jvion’s clinical AI, payers and providers can:

  • Predict utilization independent of the patient’s clinical condition
  • Proactively guide patients to the most appropriate care setting
  • Surface the risk factors that if addressed are most likely to have the greatest impact and develop effective care strategies
  • Reduce revenue loss

Key products for Cost & Utilization include:

  • Avoidable ED Visit: All-Cause
  • Readmission: All-Cause
  • Avoidable ED Visit: CHF
  • Readmission: Dual-Eligible
  • Readmission: CHF
  • Readmission: Post-Discharge

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Featured Product

Avoidable Admissions

The cost of an avoidable admission ranges from $10K – $20K and drives millions of dollars in unnecessary spending annually. Clinical resources are stretched thin and allocated to patients that could have been managed by an outpatient care coordinator. With the integration of clinical AI from Jvion, resources can be deployed more effectively and efficiently to improve outcomes and quality of care.

With Jvion, individuals on a trajectory toward an avoidable hospital admission in the next 30 to 90 days can be identified and course-corrected with proactive intervention. Course corrections earlier in the risk trajectory improve the likelihood of preventing the need for inpatient care. Reducing the total number of patients admitted lowers the demands on high-cost resources and improves capacity management.

Who We Help

Patient Impact Story

Proactive Patient Management Saves Hospital Visits and Bills

A 67-year-old male was tired of making regular trips to the hospital. Each time he went he felt like he just went through the same expensive tests over again and left with more medications to take and no understanding of what was causing his symptoms. And the medical bills were really adding up against his limited monthly income.

A few days after his last hospital discharge, the Jvion CORE used by his health plan recommended him for the hospital’s chronic care management program. A chronic care nurse reached out to him and explained it was her job to help him get the proper care and medication without having to go to the hospital. She spent time reviewing his medication challenges and sent him a package of a weight scale, blood pressure cuff, and a heart rate monitor that he could wear. The information was automatically sent to his doctor where he and the nurse could proactively manage and intervene where needed. As a result, hospitals visits are almost non-existent and his health has improved substantially.


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  • Download the latest SmartFocus paper “The COVID Aftermath: Why behavioral health is the next crisis health plans should be prepared to manage” brought to you by Jvion and SmartBrief to understand why the current state of analytics leave members and health plans exposed to a behavioral health crisis.

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